management_of_post_partum_urinary_retention_wha_sig_endorsed.pdf

ACT Health, Maternity Practice Guideline, Management of Post-Partum Urinary Retention. March 2009.

In conjunction with: 1

CLINICAL PRACTICE GUIDELINE

MANAGEMENT OF POST PARTUM URINARY RETENTION

Publication Date: March 2010 Document Classification: ACT Health Clinical Practice Guideline

endorsed by WHA Physiotherapy Special Interest Group June 2009

Coordinated by: Katie Vine ([email protected]) Available to: Members of Womens Hospitals Australasia Review Date: February 2012

1. PURPOSE AND SCOPE The Management of Post-Partum Urinary Retention guideline will be implemented by health professionals caring for women in the post-partum period to prevent long and short term sequelae of post-partum urinary retention.

2. POLICY

BACKGROUND There are two types of urinary retention that can affect women in the post-partum period.

Overt Retention Clinically overt urinary retention refers to the inability to void spontaneously within 6 hours of

vaginal birth or removal of IDC (Carley et al., 2002; Rizvi et al., 2005; Yip et al., 2004). Covert Retention

Covert urinary retention refers to elevated post void residual volumes of >150mL and no symptoms of urinary retention (Carley et al., 2002; Rizvi et al., 2005).

Covert retention seems to be a self limiting condition with residual volumes returning to normal with 4 days (Yip et al., 1997).

The causes for both types of urinary retention are theorised to be neurological damage associated with prolonged pressure against the pelvic floor and bladder (Carley et al., 2002; Yip


ACT Health, Maternity Practice Guideline, Management of post-Partum Urinary Retention. March 2009.

2 In conjunction with:

et al., 1998), associated pudendal, pelvic or hypogastric nerve injury (Yip, et al, 2004), and pain inhibited detrusor function (Boston, 2006).

A single episode of postpartum bladder over distension, if not diagnosed and treated early, may cause persistent urinary retention and irreversible damage to the detrusor muscle, with recurrent urinary tract infections and permanent voiding difficulties (Rizvi et al., 2005).

There are no studies investigating the long term consequence of post-natal urinary retention.

Procedure All women will be screened within four hours post-partum for risk factors and symptoms of overt and covert post-partum urinary retention.

Risk factors include: Epidural analgesia Prolonged labour Instrument-assisted delivery Nulliparity Perineal oedema Periurethral trauma

(Yip et al., 2005; Boston, 2006; Carley et al., 2002)

Previous history of retention

Symptoms of overt urinary retention include: Hesitancy Difficulty passing urine Slow or intermittent stream Straining to void Sense of incomplete emptying

(Yip et al., 2005)

Symptoms of covert urinary retention include: No symptoms of overt urinary retention No urge to void Overflow incontinence

In the instance where such symptoms are identified the health professional will then follow the relevant pathway to ensure optimal management. Overt and Covert pathways are attached as appendices A and B respectively.




In the case of overt urinary retention, non-invasive measures should be the first treatment strategy. In the post-surgical population may result in a successful void in 57% of cases (Stallard & Prescott, 1998, as cited in Yip, et al., 2004). These measures include:

Adequate analgesia Adequate hydration Ambulation, privacy Warm bath (Boston, 2006; Yip et al., 2005; Ching-Chung et al., 2002)

Documentation: A health professional should identify in the progress notes when a woman is following either pathway. The outcome of the pathway should also be documented in the progress notes.

3. EXPECTED OUTCOMES All women identified as having urinary retention receives appropriate management. All documentation is completed The woman is aware of follow-up requirements

4. POTENTIAL RISKS

This guideline will reduce the inconsistency of management of urinary retention and reduce the risk of long and short term sequelae of post-partum urinary retention.




5. REFERENCES

Boston. L. (2006). Postpartum urinary retention. Journal of the Association of Charted Physiotherapists in Womens Health, 98, 53-60.

Carley, M.E., Carley, J.M., Vasdev, G., Lesnick, T.G., Webb, M.J., Ramin, K.D. & Lee, R.A. (2002). Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery. American Journal of Obstetrics and Gynecology, 187, 430-433.

Ching-Chung, L, Shuenn-Dhy, C, Ling-Hong, T., Ching-Chang, H., Chao-Lun, C. & Po-Jen, C. (2002). Postpartum urinary retention: assessment of contributing factors and long-term clinical impact. Australian and New Zealand Journal and Obstetrics and Gynecology, 42(4), 367-370.

Rizvi, R.M., Khan, Z.S. & Khan, Z. (2005). Diagnosis and management of postpartum urinary retention. International Journal of Gynecology and Obstetrics, 91, 71-72.

Rogers, R.G. & Leeman, L.L. (2007). Postpartum genitourinary changes. Urologic Clinics of North America, 34, 13-21.

Stallard, S. & Prescott, S. (1998). Postoprative urinary retention in general surgical patients. British Journal of Surgery, 75, 114101143.

Yip, S., Sahota, D. & Pang, M. (2005). Postpartum urinary retention. Obstetrics & Gynecology, 106(3), 602-606.

Yip, S., Sahota, D., Pang, M. & Chang, A. (2004). Postpartum urinary retention. Acta Obstetricia et Gynecologica Scandinavica, 83, 881-891.

ENDORSED BY

------------------------------------------- -------------------------------

Liz Sharpe Date: Director of Nursing and Midwifery Womens and Babies The Canberra Hospital

AUTHORISED BY

----------------------------------------- ----------------------------

Anne Sneddon Date: Director O&G Womens and Babies The Canberra Hospital


5

In conjunction with:

MANAGEMENT OF POST PARTUM URINARY RETENTION APPENDIX B



management_of_post_partum_urinary_retention_wha_sig_endorsed.pdf

Documents